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P4"`-" SAN JOAQUIN COUNTY <br /> r y ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: a <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. �;;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> 6%A " i�� ' Date: <br /> AY ...Orgy i it <br /> Address: }(i'tn City: r � %f/�� Zip Code: �' r <br /> t <br /> Owner/Operator: Telephonel O.7 T <br /> Program Element: <br /> Program Record: l r f ^� Inspection Type:/' F <br /> SB180 Posted (Yes) <br /> ' No Permit Posted Yes No Re-Inspection on or After: <br /> / I�- <br /> ;> lrs: <br /> A, Md., 0,Ult'-11y n x e. ijyl 1,)-Yvj <br /> y <br /> GU <br /> 1 i i <br /> I.-I 1 , � "J V`ice) r <br /> t..t�-rSsC.� <br /> y <br /> It �1'1' ..• <br /> ,��1�'; <br /> . � 1 i.hV- - r i t <br /> PRA1 <br /> J <br /> G.t 1 <br /> Temperature :, 1.Itep <br /> Y Y . P Warewashing <br /> Food Safety Certification � - Facilit ,Hot Water Temperature , , <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: ! _ - <br /> n <br /> EH Specialist: (.� a ( Phone: <br /> Time in: �� � /( Time Out: / Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />